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Reliability of point-of-care coagulometer measurements in patients with acute ischaemic stroke receiving intravenous fibrinolysis.

Authors
  • Guisado-Alonso, D1
  • Fayos-Vidal, F2
  • Martí-Fàbregas, J2
  • Prats-Sánchez, L2
  • Marín-Bueno, R2
  • Martínez-Domeño, A2
  • Delgado-Mederos, R2
  • Camps-Renom, P2
  • 1 Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España. Electronic address: [email protected]
  • 2 Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España.
Type
Published Article
Journal
Neurologia (Barcelona, Spain)
Publication Date
Apr 01, 2020
Volume
35
Issue
3
Pages
155–159
Identifiers
DOI: 10.1016/j.nrl.2017.07.017
PMID: 28958393
Source
Medline
Keywords
Language
Spanish
License
Unknown

Abstract

Speed of administration conditions the effectiveness of intravenous fibrinolysis in treating acute ischaemic stroke. To reduce the risk of haemorrhagic complications, the intervention is contraindicated in certain cases, such as where the International Normalised Ratio (INR) is ≥ 1.7. This study aimed to determine the reliability of point-of-care INR readings (POC-INR) taken using the CoaguChek® XS portable coagulometer compared to laboratory results (L-INR). We conducted a retrospective observational study of consecutive patients admitted to our centre with acute ischaemic stroke and who were treated with intravenous fibrinolysis, over a period of 4 years. Patients' INR was measured with a portable coagulometer and in the laboratory. Results were compared using the paired-sample t test; using L-INR results as a reference value, ROC analysis was performed to determine POC-INR with greater predictive value. The study included 210 patients with a mean age of 74.3±11.5 years old; 18 (8.6%) were taking vitamin K antagonist oral anticoagulants (OAC). There were no significant differences between the 2 INR measurements in the population as a whole (POC-INR-L-INR difference: 0.001±0.085; P=.82). In subgroup analysis, the results coincided for patients taking OACs (0.001±0.081; P=.42) and those with L-INR ≤ 1.2 (0.008±0.081; P=.16). For L-INR>1.2, however, the portable coagulometer underestimated INR (0.058±0.095; P=.01). Through ROC analysis, POC-INR < 1.6 was found to be the cut-off point with greatest sensitivity (100%) and specificity (98.97%) for identifying patients eligible for intravenous fibrinolysis (L-INR < 1.7). POC-INR shows a good correlation with L-INR. Our results suggest that the best threshold to predict an L-INR < 1.7 is POC-INR < 1.6. Internal validation studies for POC-INR should be considered in all treatment centres. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

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